Outcomes after progression of disease with anti–PD‐1/PD‐L1 therapy for patients with advanced melanoma. Issue 15 (28th May 2020)

• Record Type: Journal Article
• Authors: Patrinely, James R.; Baker, Laura X.; Davis, Elizabeth J.; Song, Haocan; Ye, Fei; Johnson, Douglas B.
• Is Part Of: Cancer. Volume 126:Issue 15(2020)
• Page Start: 3448
• Page End: 3455
• Publication Date: 2020-05-28
• Subjects: immunotherapy -- ipilimumab -- melanoma -- nivolumab -- programmed cell death protein 1 (PD‐1) -- pembrolizumab -- progression; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.32984
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: Greater than one‐half of patients with melanoma who are treated with antibodies blocking programmed cell death protein 1 receptor (anti–PD‐1) experience disease progression. The objective of the current study was to identify prognostic factors and outcomes in patients with metastatic melanoma that progressed while they were receiving anti–PD‐1 therapy. Methods: The authors evaluated 383 consecutively treated patients who received anti–PD‐1 for advanced melanoma between 2009 and 2019. Patient and disease characteristics at baseline and at the time of progression, subsequent therapies, objective response rate (ORR), overall survival, and progression‐free survival were assessed. Results: Of 383 patients, 247 experienced disease progression. The median survival after progression was 6.8 months. There was no difference in survival noted after disease progression based on primary tumor subtype, receipt of prior therapy, or therapy type. However, significantly improved survival after disease progression correlated with clinical features at the time of progression, including normal lactate dehydrogenase, more favorable metastatic stage (American Joint Committee on Cancer eighth edition stage IV M1a vs M1b, M1c, or M1d), mutation status ( NRAS or treatment‐naive BRAF V600 vs BRAF / NRAS wild‐type or treatment‐experienced BRAF ‐mutant), decreasing tumor bulk, and progression at solely existing lesions. After progression, approximately 54.3% of patients received additional systemic therapy. A total of 41 patients received BRAF/MEK inhibition (ORR of 58.6%, including 70.4% for BRAF/MEK‐naive patients), 30 patients received ipilimumab (ORR of 0%), and 11 patients received ipilimumab plus nivolumab (ORR of 27.3%). Conclusions: The current study identified prognostic factors in advanced melanoma for patients who experienced disease progression while receiving anti–PD‐1, including lactate dehydrogenase, stage of disease, site of disease progression, tumor size, and mutation status. Abstract : The current study analyzes patients with metastatic melanoma who demonstrate disease progression while receiving anti–PD‐1 to identify prognostic factors of postprogression survival and outcomes with subsequent therapies. The authors report that lactate dehydrogenase, metastatic stage, progression site, tumor size, and mutation status all significantly correlate with postprogression survival and may be useful prognostic factors for clinicians.